Central nervous system mucormycosis (CNS-M) is a severe disease with difficult and often delayed diagnosis, leading to high mortality. The aim of this new study was to assess clinical and radiological presentation according to underlying conditions and dissemination routes to optimize diagnostic strategies. We conducted a retrospective national study including 54 CNS-M cases diagnosed between 2005 and 2020, with brain imaging reviewed by two neuroradiologists. CNS-M resulted from presumed hematogenous dissemination in 29 patients (54%) and from direct extension in 25 (46%), known as rhino-orbito-cerebral mucormycosis (ROCM). No neurological symptoms were found in 10/54 (19%), regardless of dissemination route. Hematogenous CNS-M mainly affected highly immunocompromised (HM or SOT) patients (90%), including 43% neutropenic. Radiology showed abscesses (87%) and small-vessel disease (39%). In ROCM, two patterns emerged depending on osteolysis (19/25, 76%) or its absence (6/25, 24%). ROCM without bone lysis, mostly in severely immunosuppressed patients, caused meningitis without abscess, whereas osteolytic ROCM led to abscess formation (11/18, 60%). Without osteolysis, perineural spread along the optic nerve occurred in 2/3 cases. Serum Mucorales PCR was positive in 91% of hematogenous and 64% of ROCM cases. Fungal co-infections occurred in 26%. This study underscores distinct invasion patterns and the need for extensive workup in CNS-M, highlighting the diagnostic value of MRI with gadolinium and serum Mucorales qPCR based on dissemination route and underlying condition. MRI is particularly useful in ROCM for detecting meningitis (80%), large-vessel disease (30%), and perineural involvement (8%).

Introduction: Tonsil-related cervical necrotizing fasciitis (t-CNF) is a rare but life-threatening complication of a usually benign infection. Determinants of progression from peritonsillar infection to t-CNF remain poorly understood, and no study has specifically investigated this transition. We aimed to identify factors associated with t-CNF, focusing on anti-inflammatory drug exposure and unrecognized underlying diseases. Methods: We conducted a retrospective single-center study (2017–2024) in a tertiary ENT referral center. Adult patients with surgically managed tonsillar infections were included. Patients with t-CNF were compared with those with peritonsillar abscess. The primary outcome was identification of factors associated with t-CNF occurrence; secondary outcomes included clinical outcomes, risk factors for complicated t-CNF, and prevalence of previously undiagnosed immunosuppressive conditions. Findings: Among 281 patients, 85 had t-CNF and 196 had peritonsillar abscess. In multivariable analysis, pre-admission NSAIDs (aOR 4.57, p<0.001) and corticosteroids (aOR 3.40, p=0.007) were independently associated with t-CNF, along with older age and male sex. Microbiological profiles significantly differed between groups. Systematic screening identified previously unrecognized immunosuppressive diseases in 50% of patients. Mortality was low (<5%); notably, no hypoxic cardiac arrest occurred in patients with tracheotomy. Interpretation: t-CNF is associated with modifiable exposures and a high prevalence of occult immunosuppression. These findings support cautious use of anti-inflammatory drugs and systematic screening for underlying disease, and highlight the importance of early referral to expert centers with proactive airway management.​Funding. None.

Sinonasal and petrous bone fungal infections are rare and life-threatening conditions that essentialy arise in immunocompromised patients. They are mainly due to Aspergillus in patients with hematological diseases and to Mucorales in diabetic. Invasive fungal sinusitis can be acute (invasive aspergillosis, rhino-orbito-cerebral mucormycosis) but chronic invasive sinusitis can also exist (invasive chronic fungal sinusitis and granulomatous invasive fungal sinusitis). Petrous bone fungal infections are similar to bacterial necrotizing otitis externa and are most often due to Aspergillus. The diagnosis must be made as early as possible with surgical biopsies, to allow early therapeutic management. Histopathological analysis is essential to confirm the diagnosis. The treatment is multidisciplinary and combines antifungal treatments with etiological care, sometimes associated with debridement surgery especially for mucormycosis.

Background:. Total reconstruction of the alar nasal subunit, often following traumatic or oncological amputation, presents a significant reconstructive challenge. This study compares the nasolabial flap (NLF) and the paramedian forehead flap (PFF) for their aesthetic and functional outcomes in this specific context. Methods:. A prospective, monocentric study included 28 patients who underwent total alar subunit reconstruction between 2017 and 2024. Patients were allocated to 2 groups based on the reconstructive technique: folded PFF or NLF. Postoperative assessment included patient satisfaction surveys and the Nasal Aesthetic and Functional Evaluation Questionnaire score to evaluate functional and aesthetic outcomes. Results:. Reconstruction with the PFF provided superior aesthetic outcomes compared with the NLF, with a mean Nasal Aesthetic and Functional Evaluation Questionnaire aesthetic score of 30 out of 35 versus 21.6 out of 35 (P = 0.01). No significant difference was found in functional scores. The PFF, however, required a significantly higher number of operative stages (mean 3.6 versus 1.4, P < 0.001). This procedural complexity influenced patient choice, with those prioritizing a limited number of procedures opting more frequently for the NLF. The surgical decision was guided by pre- and postoperative photographic analysis in 71% of cases. Conclusions:. For total alar subunit reconstruction, the PFF offers superior aesthetic results at the cost of greater procedural complexity compared with the NLF. This study underscores the necessity of an individualized, patient-centered approach, balancing aesthetic goals against the surgical burden through shared decision-making.

Background: Sinonasal undifferentiated carcinoma (SNUC) is an extremely rare, high-grade, and aggressive tumor of the sinonasal tract. Due to the rarity of this malignancy, current treatment guidelines are based on small and often/mainly single-center retrospective datasets. In the absence of a universally accepted standard of care for SNUC, treatment approaches vary across countries and institutions, reflecting real-world clinical practice. The primary aim of this study was to describe real-world treatment and outcomes for patients with confirmed SNUC. Methods: This was an international, multi-center, retrospective, observational cohort study that pooled patients into the largest SNUC dataset to date. Fifteen centers were enrolled to contribute data, including seven from Europe, four from the United States, three from the United Kingdom, and one from Canada. In the absence of a universally accepted standard of care for SNUC, treatment approaches varied across countries and institutions, reflecting real-world clinical practice. Patients included were those with histologically confirmed SNUC who were treated between 1997 and 2021. Results: This study yielded 485 patients treated for SNUC. The median age at diagnosis was 55.6 years (IQR: 44.5-67.6), and 63.7% were male. Most cases presented at advanced stages, with 70.8% as T4a or T4b. Overall survival (OS) outcomes were available for 412 patients, with a median follow-up of 26.0 months. The 5- and 10-year OS were 47.2% (95% CI: 40.8-53.3%) and 39.6% (95% CI: 32.5-46.6%), respectively. Advanced age, dichotomized T-stage (T4a/b vs. T1-3), M-stage, and orbital involvement were significant poor prognostic factors on univariable analysis (p's < 0.01). On multivariable analysis, orbital involvement (HR: 2.73, 95% CI: 1.42-5.27, p = 0.003) and distance metastasis stage (HR: 3.00, 95% CI: 1.25-7.21, p = 0.014) were both independently associated with worse OS. Conclusions: This observational study presents the largest multi-center cohort analysis of SNUC to date, providing new insights into prognostic factors for a rare cancer treated at global centers of excellence. Orbital involvement and the presence of metastases are candidate independent risk factors associated with poorer OS.

INTRODUCTION:In the GORTEC 2016-02 SANTAL randomized trial, patients at intermediate-to-high risk of relapse underwent postoperative radiotherapy ± cisplatin. This ancillary study aimed to evaluate the adequacy of surgery and operative reporting of salivary gland carcinomas (SGC). MATERIALS AND METHODS:An independent post-hoc analysis of operative and pathological reports was undertaken for 87 patients with salivary gland carcinomas treated at 26 French centers. Surgical quality was assessed with respect to REFCOR guidelines. The quality of operative reporting was investigated. For both, deviations were classified as major, minor, or absent. RESULTS:Parotid tumors accounted for 53% of cases, submandibular 15%, and minor salivary glands 32% with 37% of adenoid cystic carcinomas. Total or extended parotidectomy was performed in 90.5% of parotid cases, and neck dissection in 70%. Operative reports were rated as adequate in 72% of cases, with 14% minor and 14% major deviations. The rates of inadequate surgical reporting varied between study centers. Surgical procedures were concordant with REFCOR guidelines in 62% of cases, or rated as minor deviations in 22%, 1% as not assessable, and 20% as major deviations, the latter by inadequate neck management or inadequate revision surgery after R2 resection. Quality of reporting by center was correlated with conformity of surgery. Deviations were well balanced between the two trial arms. CONCLUSION:Deviations from standardized surgical reporting and from REFCOR surgical guidelines were observed. These may influence postoperative radiotherapy planning; their impact on patient outcomes remains to be determined.

KEY POINTS:Young adults show more advanced sinonasal cancers than older patients. Histologic distribution differs markedly between young and older sinonasal cancers. Overall survival is similar between young adults and older patients despite differences.

BACKGROUND AND OBJECTIVE:Rhino-orbito-cerebral mucormycosis (ROCM) is a life-threatening fungal infection in immunocompromised or diabetic patients, with mortality between 56 and 73% when the brain is involved. Standard management often fails to halt progression. The MICA (French to summarize the therapeutic strategy combining Mucormycosis management with Invasiveness and Cranial involvement treated with surgery and high-dose Amphotericin B therapy), protocol evaluated whether systematic surgical reassessment combined with liposomal amphotericin B could improve outcomes. METHODS:Patients underwent extensive surgery reaching the skull base, followed by liposomal amphotericin B. Three-month survival was the primary endpoint. Baseline CT/MRI guided staging and resection; second-look imaging and surgery were performed on day 7. RESULTS:Six patients with advanced ROCM (hematologic malignancy or diabetes) were treated. Mortality was 66.7%, driven by rapid progression, skull base invasion and systemic complications; only one patient achieved complete remission. CONCLUSION:Early surgical reassessment and close monitoring may enhance survival, but mortality remains high in cases with hematologic malignancies, and brain involvement. SIGNIFICANCE:This study highlights the critical need for early, multimodal management, optimized control of comorbidities, and enhanced therapeutic strategies, including timely surgical re-exploration, to reduce the persistently high mortality associated with ROCM.

BACKGROUND:Adenoid cystic carcinoma of the anterior craniofacial region (ACF-ACC) is challenging to treat due to extensive subclinical spread and proximity to critical structures. Although surgery followed by radiotherapy (RT) is the current standard, real-world outcomes with modern photon and particle therapy remain insufficiently characterized. METHODS:We retrospectively analyzed 578 patients with ACF-ACC treated at eight international centers (1984-2023). Clinicopathologic features, treatment patterns, and outcomes were assessed. Anatomical extension was classified using hierarchical clustering. Comparative analyses of gross total resection (GTR) and non-surgical treatment (NST) were adjusted using propensity score matching and multivariable Cox and Fine-Gray models. Primary endpoints were local recurrence-free survival (LRFS) and cumulative incidence of local recurrence (LRCI). RESULTS:Most tumors arose in the sinonasal tract (75.8%) and were low/intermediate grade (68.6%). Long-term outcomes showed high local and distant recurrence (20-year LRCI: 74.1%; cumulative incidence of distant metastasis: 55.6%). GTR followed by adjuvant RT, especially with proton therapy (PT), achieved the best local control. R2 resections provided no advantage over NST. Within the NST cohort (n = 110), PT yielded higher complete response rates than photon RT, while responders demonstrated local control comparable to surgically treated patients. Ten-year ≥G3 toxicity incidence was 36%. CONCLUSIONS:For ACF-ACC, GTR plus modern RT provides the strongest local control, and R2 surgery should be avoided. PT is an effective definitive option for selected patients, supporting future response-guided treatment strategies.

OBJECTIVES:The aim of this study was to compare the clinical features, microbiological diagnosis, and management of bacterial and fungal skull base osteomyelitis (SBO). METHODS:A single-center retrospective study was conducted between January 2012 and August 2022 at Lariboisière Hospital in Paris, including patients treated for SBO, defined by the presence of compatible symptoms and bone involvement on computed tomography or magnetic resonance imaging. RESULTS:One hundred and twenty-seven patients were included: 97 with bacterial SBO and 27 with fungal SBO. The median age was 72.3 (65.6-81.2) years, and 106 (83%) patients had diabetes. Patients with fungal SBOs had more headache (44% vs 8%, P < 0.001), facial paralysis, and cranial nerve palsy (48% vs 24%, P = 0.013, and 30% vs 9%, P = 0.012) than those with bacterial SBOs. In cases of fungal SBOs, the imaging diagnosis of central venous thrombosis (33% vs 11%, P = 0.014), nerve infiltration (44% vs 11%, P < 0.001), or collection (48% vs 23%, P = 0.009) was more frequent. There was no significant difference in overall 1-year mortality between the two groups (10% vs 15%, P = 0.52), but the fungal nature of SBO was associated with intensive care unit admission or disease-specific mortality in a multivariate logistic analysis (odds ratio 3.56 [1.04-12.60], P = 0.043). CONCLUSIONS:This study highlights the clinical severity and morbidity associated with fungal SBOs.

Cocaine-induced midline destructive lesions (CIMDL) represent a rare but severe consequence of intranasal cocaine abuse, occasionally progressing to skull base involvement with life-threatening complications. The aim of this manuscript is to describe an exceptional case of CIMDL with clival destruction and brainstem exposure, and to review current management strategies based on a systematic literature review. We report a unique case of a 39-year-old woman with CIMDL extending to the clivus, resulting in encephalocele with basilar artery and brainstem exposure. Surgical repair was performed using a temporo-parietal fascia flap (TPFF), followed by a secondary repair with a free omental flap. A systematic review of the literature was conducted according to PRISMA guidelines, including all relevant cases of skull base involvement in CIMDL. Of 337 studies screened, 12 met inclusion criteria. Among these, surgical approaches varied widely, with a subset of patients managed conservatively, and no clearly preferred surgical strategy emerging. Outcomes highlight the feasibility and limitations of each approach and the importance of individualized surgical planning. This report emphasizes the importance of early multidisciplinary intervention and provides practical insights for the management of potentially fatal cases in selected CIMDL with skull base destruction. Moreover, it exposes the need for individualized surgical planning and reconsideration of conventional abstinence-based timing criteria in selected high-risk cases. This review also highlights the challenges in the development of standard management guidelines due to the rarity nevertheless heterogeneous scenarios of these clinical entities.

This technical note presents quadrangular cartilage disarticulation septoplasty, a novel method for complex septal deviations by resolving growth conflicts between the quadrangular cartilage, vomer, and perpendicular plate. The technique systematically releases cartilage insertions while preserving superior piriform attachments, avoiding resection-related complications. In 7 patients with "watch-glass" deformities, outcomes improved significantly: Nasal Obstruction Symptom Evaluation scores dropped from 15.4 ± 2.4 to 6.0 ± 5.9 (P = .022); Nasal Appearance and Function Evaluation Questionnaire scores rose from 38.8 ± 8.1 to 58.1 ± 8.1 (P = .014). All cases were outpatient with 24-hour splint removal, showing 0% revisions vs. 3.8% with Cottle technique. The biomechanical rationale aligns with septal development anatomy, preserving native structure. Though technically demanding, its efficiency and safety (no perforations/saddle deformities) make it promising for complex deviations. Multicenter studies are needed to compare efficacy to traditional techniques.

Salivary gland tumors are a rare and heterogeneous group of lesions with diverse microscopic appearances and variable clinical behavior. The most common salivary gland tumor subtype, pleomorphic adenoma (PA), can undergo malignant transformation into carcinoma ex pleomorphic adenoma (CXPA). Carcinomatous transformation from PA to CXPA is a highly progressive and multistep process. Distinguishing a PA with some atypia from a low-grade intracapsular or minimally invasive CXPA is primarily subjective as no mitotic count thresholds exist to help pathologists distinguish between them in difficult cases. In this prospective study, we collected 140 cases encompassing both PA and CXPA to study their molecular signatures. The primary objective was to investigate the use of DNA methylation profiling as a potential molecular tool for differentiating between these 2 entities. Methylation analysis was performed on 33 PA cases and 33 CXPA cases. We were able to demonstrate that based on their methylation profiles, PA and CXPA could be classified into 3 distinct clusters that we called benign, intermediate, and malignant. We also revealed that the presence of TP53, HRAS, PTEN, and/or TERT pathogenic mutations were exclusively present in CXPA cases and that chromosomal alteration on chromosomes 5 and 8 are potentially associated with malignant transformation. In conclusion, our study provides a comprehensive molecular framework for PA and CXPA. The presence of a pathogenic mutation in TP53, HRAS, PTEN, or pTERT or HER2 amplification could be integrated into a molecular diagnosis of CXPA for tumors within the PA-CXPA spectrum. In the future, we aim to improve our methylomic classification to make it a precision medicine diagnostic tool for the treatment management of tumors within the PA-CXPA spectrum.

BACKGROUND:Early predictive factors of metastatic cervical paragangliomas (cPG) are lacking. METHODS:This multicenter retrospective study included patients with at least one cPG. Metastatic cPG were defined by the histological presence of lymph node metastases or distant metastases. Clinical, radiological, intraoperative, histological, and mutational status characteristics were collected. Predictive factors of metastatic cPG were searched using logistic regression. RESULTS:Sixty-seven patients were included, corresponding to 86 cPG; 12.8% of these were metastatic. The seven newly identified risk factors were: presence of necrosis (OR = 12.36, 95% CI: [3.03-55.66]), extracapsular extension (OR = 33.42, 95% CI: [2.48-4752.00]), and pathological lymph nodes (OR = 25.00, 95% CI: [3.96-276.07]) on morphological imaging (MRI and/or CT); heterogeneous tumor uptake (OR = 15.5, 95% CI: [2.31-143.68]) and abnormal lymph node uptake (OR = 16.5, 95% CI: [2.04-174.94]) on functional imaging (FDG-PET-CT); invasion of adjacent tissues (OR = 34.63, 95% CI: [3.82-4602.65]) and sacrifice of noble structures (OR = 75.9, 95% CI: [7.99-10230.73]) in patients who underwent surgery. CONCLUSION:These risk factors could be combined to promptly identify aggressive cPG and adapt therapeutic strategy.

Chronic rhinosinusitis with nasal polyps (CRSwNP) is an upper airways disease predominantly characterized by type 2 (T2) inflammation, leading to reduced quality of life and patient/healthcare burden. Many patients remain underdiagnosed for T2 inflammation in clinical practice as it is not often defined/considered, resulting in inadequate disease management. This research aimed to develop and evaluate a patient management plan (PMP) to be used by healthcare professionals (HCPs) in clinical practice to improve the management and standardization of management of patients with CRSwNP in Europe. A working group of six otorhinolaryngology (ORL) specialists and one patient advocacy group (PAG) representative, who form part of the European CRSwNP Alliance, developed the PMP. Two online surveys were disseminated to ORLs/PAGs and national CRSwNP Alliance members in December 2024 and January 2025, respectively, to evaluate the design and potential utility of the PMP in clinical practice across Europe. Survey 1 respondents agreed that key themes in the initial PMP (patient symptoms, management of comorbidities, agreed treatment goals, follow-up management) were likely to be effective in improving patient management. Respondents across both surveys suggested that the PMP would improve shared decision-making, follow-up, adherence, and increase understanding of CRSwNP as a chronic inflammatory condition. They agreed that the PMP could standardize the management of CRSwNP across Europe. The PMP could support patient–HCP education and communication, supplement management guidance, enhance shared decision-making, and ensure a timely, personalized, long-term treatment and management approach, including follow-up, for patients with CRSwNP.

INTRODUCTION:As the demand for otolaryngologists increases, there is a need to address workforce and training challenges. Technological advancements, such as high-fidelity 3-dimensional (3D) simulations, may help train the future workforce-particularly for conditions with limited exposure, such as sinonasal and skull base cancers. AIMS:This study aimed to develop and validate a high-fidelity head and neck model, created using proprietary 3D printing technology, to simulate sinonasal and skull base surgery. METHODOLOGY:The sinonasal and skull base models were designed and produced using proprietary 3D printing technology (Fusetec). 3D printed models were incorporated into a 2-day dissection course. Surveys were completed by delegates and faculty on the course, with delegates having their surgical performance assessed using the Objective Structures Assessment of Technical Skills (OSATS). RESULTS:A total of 21 delegates and 10 faculty had utilized the 3D printed models for sinonasal and skull base surgery training. Overall, 71.4% of delegates (n = 15) and 70.0% (n = 7) of faculty rated the realism of the models as very good/excellent. The mean pre course OSATS score was 22.57/40 (SD ±6.88) and the post course OSATS score was seen to be 25.7/40 (SD ±4.70; P < .0001). The total confidence reported by delegates prior to the course was 25.8/45 (SD ±7.00) and following the course the self-reported confidence was 33.6/45 (SD ±3.62; P < .001). CONCLUSION:This study developed and validated a novel 3D model for simulating sinonasal and skull base surgery, which improved surgical performance amongst participants. This offers a potential training solution to address workforce challenges in Otolaryngology.

OBJECTIVES:Recent shortages of amoxicillin and amoxicillin/clavulanate in France have raised concerns about a possible impact on the management and outcome of acute sinusitis. We therefore assessed the rates of complicated sinusitis occurring during two time periods, one with and one without antibiotic shortages. METHODS:We reviewed cases of sinusitis from two periods: December-February 2018-19 and 2019-20 (no antibiotic shortages) and December-February 2021-22 and 2022-23 (shortages of amoxicillin and amoxicillin/clavulanate). We included all patients over 15 years of age who had been treated in the hospital's ear, nose and throat department of Lariboisiere hospital for sinusitis. The primary outcome was the rate of complicated sinusitis among the total number of cases of sinusitis treated at Lariboisière hospital during the two study periods. RESULTS:One hundred and forty-two patients were treated for sinusitis during the study periods: 60 during the no-shortage period and 82 during the shortage period. The rate of complicated sinusitis was significantly higher during the shortage period (23/82, 28%) than during the no-shortage period (3/60, 5%) (OR 7.32, CI [2.04-40.15], p=0.0003). The use of alternative antibiotics prior to attendance was independently associated with an increased risk of complications (OR 7.88, CI [1.58-77.87], p=0.004). The presence of oral streptococci was also associated with complications, suggesting a correlation between microbial patterns and antibiotic shortages. CONCLUSIONS:Shortages of first-line antibiotics for sinusitis was associated with an increased rate of complications, highlighting the need to explore alternative treatments and reinforce public health actions to anticipate shortages.

INTRODUCTION:Sinonasal sarcomas are exceedingly rare entities, constituting less than 7% of head and neck sarcomas. Their complex histology needs specialized treatment, which is often based on multimodal approaches including surgery, radiation therapy, and/or chemotherapy. This manuscript aims to gather expert opinions to establish common management principles for sinonasal sarcomas. METHODS:This international consensus followed a modified Delphi method in seven steps, including statements definition by the core group, expert panel recruitment, and a two-round survey. Sixty-two statements on sinonasal sarcoma management were developed. Experts from multiple continents participated, and results were anonymized and analyzed between March and May 2025. RESULTS:A total of 44 invited experts were recruited, 43.2% otorhinolaryngologists/head and neck surgeons, 31.8% medical oncologists, and 25% radiation oncologists. Participants varied in age and experience, representing Europe (70.5%), North America (18.2%), South America (6.8%), and Asia (4.5%). Among all histologies, biphenotypic sarcoma, chondrosarcoma, leiomyosarcoma, and myofibrosarcoma are principally treated with an upfront surgical management, differently from Ewing sarcoma and rhabdomyosarcoma in which chemotherapy, eventually associated with radiotherapy, is often chosen. In the remaining histologies (angiosarcoma, liposarcoma, malignant peripheral nerve sheath tumor [MPNST], osteosarcoma, and synovial sarcoma), a precise multimodal treatment is less standardized and needs to be discussed on a case-by-case basis. CONCLUSION:Sinonasal sarcomas require a histology-driven approach to determine upfront treatment, whether surgical, medical, or multimodal. Despite this structured strategy, prognosis remains highly variable across subtypes. Multidisciplinary evaluation and individualized management in referral centers are crucial to address the biological diversity and anatomical complexity of these rare malignancies.

Background: Sinonasal and skull base tumor surgery-related morbidity has been reduced by the use of endoscopic endonasal skull base surgery (EESBS). Postoperative radiation therapy (poRT) requires precise definition of target volumes. To enhance the accuracy of poRT planning, histological and radiological correlations are necessary to locate the tumor attachment on poRT CT scans. An accurate atlas of structures resected or identified during EESBS could serve for the interdisciplinary postoperative management of patients, personalizing poRT by adequate radiation dose delivery. The objective of this study was to achieve a consensual segmentation atlas on CT scan with surgeons practicing EESBS and radiation oncologists. Methods: The sinonasal structures relevant for poRT of sinonasal malignancies were determined by a two-round Delphi process. A rating group of 25 European experts in sinonasal malignancies was set up. Consensual structures emerged and were used to determine the anatomical limits of the retained structures to draft an atlas with expert based relevant structures. The atlas was then critically reviewed, discussed, and edited by another 2 skull base surgeons and 2 radiation oncologists. Results: After the two rating rounds, 46 structures obtained a strong agreement, 7 an agreement, 5 were rejected and 5 did not reach consensus. The atlas integrating all the selected structures is presented attached. Conclusion: Consensual segmentation atlas on CT scan might allow, through careful poRT planning to limit the morbidity of poRT while maintaining good local control. Prospective studies are necessary to validate this potential precision medicine-based approach.

Les sinusites fongiques forment un ensemble hétérogène de pathologies classées selon leur caractère invasif ou non et leur évolution aiguë ou chronique. Les formes non invasives, représentées par l’aspergillome et la sinusite fongique allergique (SFA), surviennent chez des patients immunocompétents et relèvent d’une prise en charge chirurgicale. Pour la SFA, cette dernière est associée à un traitement anti-inflammatoire par voie locale et générale. À l’inverse, les formes invasives, aiguës ou chroniques sont des urgences diagnostiques et thérapeutiques qui nécessitent un traitement antifongique adapté, la correction du terrain sous-jacent et une chirurgie de débridement précoce dans les formes nécrosantes. Leur pronostic reste sévère en cas de retard diagnostique ou d’extension orbito-cérébrale.